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Opioid-use disorder (OUD), a risk factor and major contributor to opioid-related deaths, is often underdiagnosed and undertreated.  Currently there are three FDA-approved pharmacologic treatments for OUD maintenance therapy: methadone, buprenorphine (with or without naloxone), and naltrexone.  Despite definitive evidence that methadone and buprenorphine products are effective in the treatment of OUD, there are still considerable accessibility and availability barriers that patients face when seeking Medication Assisted Treatment (MAT). The EXtended-release naltrexone vs Buprenorphine/naloxone for Opioid Treatment (X:BOT) trial compared the efficacy and safety of XR-NTX and BUP-NX to induce and maintain a patient with OUD on MAT as well as reducing opioid overdoses, relapses, and cravings.

Guest Author:  Jordan L. Wulz, PharmD, MPH, BC-ADM, CHC

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Female sexual dysfunction (FSD) effects women of all ages but is common among perimenopausal / postmenopausal women and may be related to a reduction in circulating estrogen.  Oral estrogens increase sex hormone-binding globulin (SHBG) which lowers available free testosterone and thus may negatively impact sexual function.Transdermal estrogens are typically preferred because they lack a high first-pass effect and are not associated with risk of thromboembolic events. However, additional research – directly comparing oral and transdermal preparations – was needed.  An ancillary study of the Kronos Early Estrogen Prevention Study (KEEPS) did just that - examined the impact of oral and transdermal estrogens on sexual functioning.

Guest Authors:  Stefanie C. Nigro, PharmD, BCACP and Christine Dimanculangan, Pharm.D.

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A recently published study explores the possible benefits to discontinuing an alpha-1 blocker after receiving combination therapy with a 5-alpha reductase inhibitor for the treatment of benign prostatic hyperplasia (BPH).  In more symptomatic patients, or patients with confirmed, enlarged prostates, it is recommended to use both medication classes (alpha-1 blocker and 5-alpha reductase inhibitor) to minimize symptoms by relaxing the prostatic smooth muscle and reducing the size of the prostate – producing a potentially synergistic effect.  This study found that withdrawal of alpha 1-blockers after a year of combination therapy did not worsen urinary symptoms, QOL, and voiding or storage function.  This provides evidence that combination therapy may not be needed indefinitely for all patients.

Guest Authors:  Erica Crannage, PharmD and Stephanie Crist, PharmD

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A recently published study explores the possible benefits to discontinuing an alpha-1 blocker after receiving combination therapy with a 5-alpha reductase inhibitor for the treatment of benign prostatic hyperplasia (BPH).  In more symptomatic patients, or patients with confirmed, enlarged prostates, it is recommended to use both medication classes (alpha-1 blocker and 5-alpha reductase inhibitor) to minimize symptoms by relaxing the prostatic smooth muscle and reducing the size of the prostate – producing a potentially synergistic effect.  This study found that withdrawal of alpha 1-blockers after a year of combination therapy did not worsen urinary symptoms, QOL, and voiding or storage function.  This provides evidence that combination therapy may not be needed indefinitely for all patients.

Guest Authors:  Erica Crannage, PharmD and Stephanie Crist, PharmD

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It’s been 20 years since alendronate was approved to treat osteoporosis.  Although effective, bisphosphonates aren’t ideal. Romosozumab is an investigational monoclonal antibody that increases bone formation and decreases bone resorption. Is romosozumab a potentially better alternative to bisphosphonate therapy?  That’s what the ARCH study attempted to answer.

Guest Authors:  Yanqun Evonne Lee, MClinPharm and Joyce Yu-Chia Lee, PharmD

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The new 2017 ACC/AHA guidelines recommend a BP goal of

Nearly 16 million adults in the United States have chronic obstructive pulmonary disease (COPD) but this is probably a woeful underestimate as many adults are asymptomatic in early stages.  Screening is only recommended if patients exhibit symptoms and have risk factors.  However, the most rapid decline in lung function occurs during GOLD stage 1. As COPD progresses, mortality, morbidity, and the economic burden increase very significantly. These facts suggest a need to detect and treat early-stage disease to slow its progression. The Tie-COPD study provides some new evidence that early treatment might be beneficial.

Guest Authors: Amy Robertson, Pharm.D. and Michelle Balli (Piel), Pharm.D.

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We’ve all seen and used the American College of Cardiology 10-year atherosclerotic cardiovascular disease (ASCVD) risk calculator. There are several modifiable risk factors such as blood pressure, cholesterol, and smoking status that, if addressed, can lower ASCVD risk. But are there other modifiable risk factors that we are failing to account for and might be able to address? New evidence suggests systemic inflammation may be one.

Guest Authors:  Ian Hatlee, Pharm.D and Scott Pearson, Pharm.D.

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We interview Eric MacLaughlin, Joseph Saseen, and Kristin Rieser about the ACC/AHA Guidelines for the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure in Adults released in November 2017.  Dr. MacLaughin, a member of the Guideline Writing Committee, gives a insiders view of the guidelines development process and explains the rationale for lower blood pressure goals.  Drs. Saseen and Rieser talk about some of the practical considerations that we all must consider as we move forward to making these recommendations a reality.

Guests:  Kristin Rieser, Pharm.D., Joseph Saseen, Pharm.D, and Eric MacLaughlin, Pharm.D.

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Since the introduction of direct oral anticoagulants (DOACs) less than a decade ago, use of this class has expanded beyond the prevention and treatment of venous thromboembolism and stroke prevention in the setting of atrial fibrillation. The potential role of DOACs in the secondary prevention of coronary artery disease (CAD) has been of considerable interest. In the setting of CAD, warfarin has resulted in significant more major bleeding when given either alone or in combination with antiplatelet agents when compared to aspirin alone.  Therefore, clinicians have been reluctant to embrace the combination of an anticoagulant plus an antiplatelet agent. However, could DOACs have a role in stable CAD? The COMPASS trial aimed to find an answer.

Guest Authors:  Candyce Bryant, Pharm.D., Joy Hoffman, Pharm.D., and M. Shawn McFarland, Pharm.D.

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